Shin Splints Causes & Treatments

Shin splints is a general term for pain in the front of the tibia or shin bone. The pain could be related to inflammation or injuries to muscle, tendon, periosteium, or bone. In some cases the pain develops because of a tibial bone stress reaction or stress fracture. Most commonly it is caused by medial tibial stress syndrome (MTSS), which is an overuse injury to the muscle and tendons of the lower leg. This is a very common repetitive stress syndrome in athletes, especially runners, and sports enthusiasts who quickly increase their activities. We also often see this syndrome in inactive individuals who begin a new workout regimen or weight loss plan that involves jumping or increased amount of body weight exercises in the hopes of quickly burning calories and losing weight.

Medial tibial stress syndrome commonly disrupts New Year's fitness programs, weight loss goals, and marathon training because the pain limits exercise activities and can be frustrating during the healing process. The condition takes weeks to improve and can be easily aggravated with returning to full activity before the tissue properly heals.

SIGNS AND SYMPTOMS OF SHIN SPLINTS

The tibialis muscle gradually becomes more tender or sore with repetitive pounding activity. It may begin as a dull ache or stiffness in the leg muscles. The leg soreness begins to increase in intensity to a moderate, dull ache and sharp pain that limits activity. Swelling may be noticeable along the inside of the leg. The muscle may become very tender to the touch, all along the muscle insertion from the knee toward the ankle. The condition can eventually make walking or running extremely painful.

COMMON CAUSES OF SHIN SPLINTS

Overuse or soft tissue injuries are commonly seen in athletes who increase their intensity or duration of activity. Sports injuries are common in runners who are running longer than they ever have before or increasing their hill running. It is common in impact sports with quick changes in direction, such as tennis or basketball. Marathon runners are commonly injured due to their volume of training mileage. This problem is most notable on long runs, when running gates become less efficient and people tend to "pound the pavement." Chronic repetitive stress syndromes and conditions can happen to people of all ages and fitness levels; care should be taken to avoid risk factors of repetitive stress syndromes.

SHIN SPLINT RISK FACTORS

In addition to over training, several risk factors include:

Jumping activities or any pounding exercise

Running with worn out or old shoes

Overpronation or excessive collapse of the foot arch during walking or running

The foot normally flattens out slightly during running or walking, however excessive collapse of the arch is called overpronation. The excessive movement causes increased stress on the muscles and tendons of the lower leg, eventually causing an overuse injury of the lower leg muscles resulting in shin splints.

TREATING LOWER LEG PAIN AT HOME AND HOW TO PREVENT IT

Home care of shin splints includes icing the leg muscles, reducing activity, and decreasing inflammation and leg symptoms. If shin soreness persists for two weeks or becomes severe, seek a health care provider for treatment.

Ice for 15 minutes. Then take the ice off for 15 minutes to let the legs warm and increase blood flow. Apply the ice again for 15 minutes to help with the pain and discomfort. Repeating this cycle several times a day can make a significant difference in your recovery. Icing can be in the form of ice packs or ice baths. Ice baths involve placing your legs in a bucket of ice and water. It should be cold but not painful.

DIAGNOSING FRACTURE vs SHIN SPLINTS?

Factors in the development of medial tibial stress syndrome will be important in diagnosing shin splints, along with the location of shin pain. In the lower leg the fibula is on the outside of the leg, and the tibia is the larger bone on the medial aspect of the lower leg. The tibia bone is often referred to as your shin bone in common terms.

Consistent and persistent tibial pain will require evaluation to rule out a stress fracture through physical exam, history or advanced imaging. X-rays and bone scans will not always be needed. If the location and timing of pain indicates a fracture, the imaging tests evaluate the bone structures. MRI's can be used to test and evaluate the soft tissues; the muscles, tendons, and ligaments that may be causing the shin condition. Specific tests will be determined by your healthcare provider based on when, where, and how bad the symptoms are along the tibia.

Pain associated with shin soreness often occurs throughout the soft tissue, especially where the tibialis anterior and tibials posterior muscles attach to the tibial bone. Shin pain deep inside the tibia may indicate a stress fracture or stress reaction. Bone fractures can take six weeks to heal, and many athletes and runners often return to their exercise workouts too early and aggravate the shins.

Drugs and supplements can be taken to help decrease pain and inflammation including NSAIDs, ibuprofen, naproxen, or aspirin. The over-the-counter medications should be taken as directed by your doctor, as they do have a risk of ulcers or increased risk of bleeding. Long term treatments using these over-the-counter medications are not recommended for chronic or general shin soreness or to prevent shin splints. Nor are the drugs a substitute for rest or help the tendons heal faster.

Conservative Treatment for SHIN SPLINTS

Conservative treatment for shin splints is aimed at decreasing inflammation, muscle spasms, and pain. Specific exercises and stretches improve foot strength and reduce overpronation. Modification of a training schedule is often required, and arch supports may be considered to control the over pronation. As with any muscle injury, expect your provider to manually stretch and work the muscles. Various muscle techniques speed recovery including massage therapy, ASTYM, Graston Technique and active stretching. In our office, we will also utilize massage therapy to improve healing and recovery, in addition to decreasing muscle spasms and soreness. People feel they respond quicker to treatment and are back running sooner when massage therapy is utilized in their treatment.

How to Prevent MTSS and Repetitive Stress Syndromes

It is important to wear proper footwear to avoid development of medial tibial stress syndrome. Not all running shoes are equal or appropriate for every runner. Some shoes provide better arch support than others. People with high arches may have difficulty finding proper fitting and supportive shoes that maintain a neutral foot during running foot strike. Specialty running stores will watch you run and properly correct for your level of pronation with specific shoes. Injury rates decrease when runners avoid running on hard surfaces everyday. Fitness and exercise activities should be slowly increased over time. Trying to rapidly increase running miles or pounding increases the risk of medial shin pain and foot arch tendinitis.

Shin splints can be successfully treated while keeping you actively pursuing your fitness and exercise goals. With proper treatment, we keep our athletes active and they do not have to take several weeks off training. Visit the services page for additional treatment descriptions for muscle and tendon injuries, especially chronic repetitive stress syndromes similar to MTSS. Preventing shin splints is a combination of conservative treatments and managing exercise activity.

For videos and descriptions of foot strengthening and proprioceptive exercises, see our Video Page.